Low-density lipoprotein cholesterol management after acute coronary syndrome in Aotearoa New Zealand: opportunities for improvement (ANZACS-QI 81).

Abstract

Aim: Our aims are to describe low-density lipoprotein (LDL) management in the year after a first acute coronary syndrome (ACS) hospitalisation and identify opportunities to further improve management.

Methods: Thirteen thousand two hundred and two patients aged over 20 years of age presenting with their first ACS (2014 to 2019), who underwent coronary angiography in the Northern Region of Aotearoa New Zealand, were identified from the All New Zealand All Cardiology Services Quality Improvement (ANZACS-QI) registry. De-identified linkage with Northern Region TestSafe and National Pharmaceutical databases enabled tracking of LDL levels and statin dispensing. Statin adherence in the year post-discharge was estimated using a medication possession ratio (MPR) with an MPR=1 defined as optimal coverage.

Results: Seventy-eight percent (n=10,395) of patients had a repeat lipid study within 12 months. Of these, 78.6% received post-discharge dispensing of high-intensity statin. Mean LDL fell from 2.691.14mmol/L in-hospital to 1.920.85mmol/L post-discharge. A total of 2,484 (23.9%) patients achieved LDL <1.4mmol/L. Among patients with optimal adherence who were dispensed high-intensity statins, 29% of patients achieved LDL <1.4 (mean LDL 1.70.63mmol/L). After repeat LDL testing, statin therapy was intensified in 7% but reduced in 11.2%.

Conclusion: Although lipid management was appropriately intensified in-hospital, only a quarter of patients achieved the current guideline LDL target. Improvements in lipid management require use of these more intensive therapies in combination with lifestyle interventions and more regular lipid testing.